BLS Albuterol

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BLS Albuterol

• Facilitated Administration

Nitin Natarajan, REMT-P/IC Training
Coordinator Hudson Valley Regional EMS Council
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Overview

• Signs and symptoms of difficulty breathing
• Anatomy
• Emergency Medical Care
• Assessment
• Medications
• Spacers
• Infant and child considerations

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Signs and Symptoms

• Shortness of breath
• Restlessness
• Increased pulse rate
• Increased breathing rate
• Decreased breathing rate
• Skin color changes
• Noisy breathing
• Silent chest

• Inability to speak
• Retractions
• Altered mental status
• Abdominal breathing
• Coughing
• Irregular breathing rhythm
• Patient in a tripod position
• Unusual anatomy

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Anatomy
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Emergency Medical Care

• Perform initial assessment
• Perform focused history and physical exam
• Important questions to ask
• Onset
• Provocation
• Quality
• Radiation
• Severity
• Time
• Interventions

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Breathing Assessment
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Special Considerations

• Should be prepared to intervene with appropriate
  oxygen administration and artificial ventilation
  support
• Use caution with children and infants

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Medications

• Medication name
• Generic albuterol, isoetharine,
  metaproteranol, etc.
• Trade Proventil, Ventolin, Bronkosol,
  Bronkometer, Alupent, Metraprel, etc.
• These are the only bronchodilators authorized for
  use. DO NOT ADMINISTER A STEROID BASED INHALER.

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Indications

• Must meet all of following criteria
• Exhibits signs and symptoms of a respiratory
  emergency
• Has a physician prescribed handheld inhaler
• Administration of the medication is authorized by
  the REMAC

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Contraindications

• Patient is not alert
• Inhaler is not prescribed for the patient
• Permission denied by Medical Control
• Patient has already taken the maximum number of
  doses

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Medication Form

• Handheld metered dose inhaler

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Dosage

• The number of inhalations is based upon medical
  directions order or physicians order based upon
  consultation with the patient

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Administration

• Obtain order from medical control, either on or
  off line
• Assure right medication, right patient, right
  route, and that the patient is alert enough to
  use the inhaler
• Check the expiration date on the inhaler
• Check to see if the patient has already taken any
  doses

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Administration (cont)

• Shake the inhaler vigorously several times
• Remove the oxygen adjunct from the patient
• Have the patient exhale deeply
• Have the patient put his/her lips around the
  opening of the inhaler
• Have the patient depress the handheld inhaler as
  he/she begins to inhale deeply

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Administration (cont)

• Instruct the patient to hold his/her breath for
  as long as he/she comfortably can so that the
  medication can be absorbed.
• Replace the oxygen adjunct on the patient
• Allow the patient to breathe a few times
• Repeat second does per protocol

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Spacers

• If the patient has a spacer device available, it
  should be used.

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Actions

• Dilates the bronchioles, reducing airway
  resistance.

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Side Effects

• Increased pulse rate
• Tremors
• Nervousness
• Nausea

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Re-assessment Strategies

• Gather vital signs and focused reassessment
• The patient may deteriorate and need positive
  pressure artificial ventilation

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Infant and Child Considerations

• Use of handheld inhalers is very common in
  children
• Chest retractions are more commonly seen in
  children than adults
• Cyanosis is a late finding in children
• Very frequent coughing may be present rather than
  wheezing, in some children.
• Emergency care is the same as long as the
  indications are present

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Questions